本文選題：早期糖尿病腎病 + 中醫(yī)體質(zhì)特征　； 參考：《浙江中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的了解寧波姜山地區(qū)早期糖尿病腎病患者的體質(zhì)分布特點,探討各種體質(zhì)對早期糖尿病腎病發(fā)生發(fā)展的影響,為中醫(yī)藥對該病不同體質(zhì)患者預(yù)防提供依據(jù)。方法研究采用王琦教授中醫(yī)體質(zhì)九分法對寧波姜山地區(qū)400例早期糖尿病腎病患者進(jìn)行中醫(yī)體質(zhì)調(diào)查,并運用頻數(shù)、百分比描述早期糖尿病腎病患者的中醫(yī)體質(zhì)類型,計量資料用均數(shù)加減標(biāo)準(zhǔn)差進(jìn)行描述,卡方檢驗或單因素方差分析來比較相關(guān)各組間的差異性,以此了解各中醫(yī)體質(zhì)類型對糖尿病腎病相關(guān)危險因素的影響。結(jié)果本研究中,通過分析入組的早期糖尿病腎病患者在各個中醫(yī)體質(zhì)構(gòu)成比,發(fā)現(xiàn)平和質(zhì)占比最多,8種偏頗體質(zhì)中,痰濕質(zhì)占13.6%,血瘀質(zhì)占9.7%,陰虛質(zhì)占8.5%,為早期糖尿病腎病的高發(fā)體質(zhì)。在中醫(yī)體質(zhì)與不同性別的研究中發(fā)現(xiàn),男性濕熱、血瘀較女性多見,而女性氣郁、陽虛為多。對不同病程研究發(fā)現(xiàn),病程在5-10年的患者人數(shù)最多,占64.3%。隨著病程的進(jìn)展,偏頗體質(zhì)種類復(fù)雜化。本研究發(fā)現(xiàn)隨著年齡的增長,早期糖尿病腎病患者人數(shù)增多,是否吸煙與中醫(yī)體質(zhì)構(gòu)成無顯著差異(P0.05),但是否有家族史的中醫(yī)體質(zhì)有差異(P0.05)。在空腹血糖的研究中,痰濕質(zhì)的空腹血糖在各個中醫(yī)體質(zhì)中均值最高；在BMI、腰圍的研究中,各組間均由顯著差異(P0.001,P0.001),其中痰濕體質(zhì)的腰圍明顯高于中國肥胖專家提出的“男性85cm,女性80cm”這一安全腰圍值,BMI均值為27.58±2.78,接近肥胖標(biāo)準(zhǔn)。痰濕質(zhì)患者腰圍、BMI與平和質(zhì)、氣郁質(zhì)、濕熱質(zhì)、血瘀質(zhì)、陽虛質(zhì)、陰虛質(zhì)、氣虛質(zhì)均由顯著統(tǒng)計學(xué)意義(P0.05,P0.01),提示痰濕質(zhì)多為形體肥胖之人：同時,痰濕質(zhì)在總膽固醇、低密度脂蛋白、甘油三酯(三項上均值均較高,且經(jīng)過單因素方差分析與其他多組均由統(tǒng)計學(xué)意義(P0.05,P0.01)。中性粒細(xì)胞與淋巴細(xì)胞比值與中醫(yī)體質(zhì)構(gòu)成有顯著統(tǒng)計學(xué)意義(P0.005),經(jīng)方差分析,血瘀質(zhì)與濕熱、陽虛、陰虛、氣虛、痰濕、平和體質(zhì)相比,差異具有顯著性(P0.05,P0.01),提示代謝性炎癥與中醫(yī)體質(zhì)中的血瘀質(zhì)密切相關(guān)。血清膽紅素在各中醫(yī)體質(zhì)類型構(gòu)成上無明顯統(tǒng)計學(xué)差異(P0.05)。本研究中,高血壓組痰濕質(zhì)、血瘀質(zhì)比例要高于非高血壓組。在有否合并心血管病的研究中,發(fā)現(xiàn)血瘀質(zhì)的占比在兩組間有顯著差異性。而在合并脂肪肝的患者中痰濕、濕熱體質(zhì)顯著高于無脂肪肝組。結(jié)論1.本研究發(fā)現(xiàn)早期糖尿病腎病患者體質(zhì)仍以平和質(zhì)為主,8種偏頗體質(zhì)中,痰濕質(zhì)、血瘀質(zhì)、陰虛質(zhì)為早期糖尿病腎病的高發(fā)體質(zhì)。2.本研究中痰濕體質(zhì)在血糖、血脂、BMI、腰圍、脂肪肝均與其他體質(zhì)有顯著差異,提示痰濕質(zhì)多為肥胖之人,多伴有脂代謝紊亂,肥胖之人血糖易偏高,可能與現(xiàn)代醫(yī)學(xué)認(rèn)為的肥胖是產(chǎn)生胰島素抵抗的重要原因相關(guān)。3.血瘀質(zhì)與心血管病密切相關(guān),且本研究中血瘀質(zhì)的中性粒細(xì)胞與淋巴細(xì)胞比值較高,提示血瘀質(zhì)與炎性因子相關(guān),血瘀質(zhì)患者需多注意糖尿病微血管并發(fā)癥的發(fā)生。
[Abstract]:Objective to understand the characteristics of the physical distribution of patients with early diabetic nephropathy in Ningbo Jiangshan area, and to explore the effects of various physiques on the occurrence and development of early diabetic nephropathy, and to provide a basis for the prevention of different physique patients with traditional Chinese medicine. Methods the nine points method of TCM constitution was used in the study of 400 cases of early diabetic kidney in the Jiangshan area of Ningbo. The patients were investigated on the physique of traditional Chinese medicine and used the frequency and percentage to describe the type of TCM Constitution of the patients with early diabetic nephropathy. The measurement data were described with the standard deviation of average number and subtraction, chi square test or single factor analysis of variance analysis were used to compare the differences among the related groups in order to solve the risk of diabetic nephropathy. In this study, in this study, by analyzing the constitution ratio of the early diabetic nephropathy in the group of early diabetic nephropathy, it was found that the proportion of flat and mass was the most, 13.6% of the 8 kinds of biased constitution, 9.7% of the blood stasis, 8.5% of blood stasis, the high incidence of Yin deficiency, in the study of the constitution of traditional Chinese medicine and the study of different sexes. Now, the male is hot and hot, and the blood stasis is more common than the female, but the female qi stagnation and yang deficiency are more. In the study of different course of disease, the number of patients in the course of 5-10 years is the most, accounting for 64.3%. with the progress of the disease and the complex physique types. This study found that with the age increasing, the number of early diabetic nephropathy patients increased, whether smoking and Chinese Medicine Constitution were smoking There was no significant difference (P0.05), but there was a difference in the constitution of traditional Chinese medicine (P0.05). In the study of fasting blood glucose, the fasting blood glucose of phlegm wet was the highest in the physical constitution of each Chinese medicine. In the study of BMI, the waist circumference of all groups were significantly different (P0.001, P0.001), and the waist circumference of the phlegm wet constitution was obviously higher than that of Chinese obesity experts. The safety waist circumference of "male 85CM, female 80cm" was 27.58 + 2.78, which was 27.58 + 2.78, close to the standard of obesity. The waist circumference of phlegm damp patients, BMI and flat and mass, qi stagnation, damp heat, blood stasis, Yang deficiency, yin deficiency and Qi deficiency were statistically significant (P0.05, P0.01), suggesting that the phlegm wet quality was mostly body fat person: simultaneously, phlegm wet quality The total cholesterol, low density lipoprotein and triglyceride (the average value of the three items were higher, and the single factor analysis of variance and other groups were statistically significant (P0.05, P0.01). The ratio of neutrophils to lymphocytes and the constitution of Chinese medicine had significant statistical significance (P0.005). The analysis of variance, blood stasis and damp heat, Yang deficiency, yin deficiency, Qi deficiency, the ratio of neutrophils and lymphocytes was statistically significant (P0.005). " Compared with physique, the difference was significant (P0.05, P0.01), indicating that the metabolic inflammation was closely related to the blood stasis in the Chinese medicine constitution. There was no significant difference in the constitution of the TCM Constitution (P0.05). In this study, the proportion of phlegm and blood stasis in the hypertension group was higher than that in the non hypertensive group. In the study of vascular disease, it was found that the proportion of blood stasis was significantly different between the two groups. In the patients with fatty liver, phlegm dampness and humid heat were significantly higher than those in the non fatty liver. Conclusion the 1. studies found that the constitution of the patients with early diabetic nephropathy was still mainly flat and qualitative, and 8 kinds of biased bodies, phlegm, blood stasis and yin deficiency were early diabetes. .2. in this study, the phlegm dampness physique in blood sugar, blood lipid, BMI, waist circumference, fatty liver are all significantly different from other physique, suggesting that the phlegm and fat are mostly obese, most of which are accompanied by lipid metabolism disorder, and the obese people are prone to high blood sugar, which may be related to the important cause of insulin resistance in modern medicine, which is related to.3. blood stasis. It is closely related to cardiovascular disease, and the ratio of blood stasis neutrophils to lymphocyte is higher in this study, suggesting that blood stasis is associated with inflammatory factors. Patients with blood stasis need to pay more attention to the occurrence of diabetic microvascular complications.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259;R277.5

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